The sort of help and support available will vary, so speak to your doctor or practice nurse about what's on offer at your practice. This could include referral to:

• A practice nurse who will help with lifestyle change and offer regular support 
• A local weight management group, either within the practice run by health professionals, or other local slimming clubs 
• A dietitian and/or a psychologist or counsellor, who can offer more individualised, specialist advice and support with managing your weight
• An exercise prescription scheme at a local leisure centre in addition to dietary support.

Or your doctor may recommend you start anti-obesity medication under their supervision.

If you have a number of medical complications your doctor may refer you to see a specialist at your local hospital to consider the best treatment option for you. For a small number of people, surgery may be considered as one of the options

There are currently two drugs approved for use as part of the medical treatment of obesity. They have been developed in recognition of the fact that it is a complex disorder, where, for example, genetic effects on appetite are very difficult to manage, especially in our weight-promoting environment. But they aren’t a magic weight loss bullet. They must still be used as part of overall lifestyle change – they just make that change more manageable for some.

The two drugs come with strict criteria about who they can be prescribed for, and for how long. Orlistat (Xenical) works by reducing the amount of fat that you absorb by about one-third, and must be taken with a low fat diet (other wise unpleasant bowel problems can result). Sibutramine (Reductil) helps you feel more satisfied with less food by regulating the action of appetite-influencing chemical messengers in the brain. Like other responsible treatments, they help people lose modest, but beneficial amounts of weight.

These two drugs have a recognised role to play in obesity treatment, and are very different from other drugs that might be available from private ‘diet clinics’ or over the Internet. These include appetite suppressants and diuretics (force the body to lose fluid). We definitely don’t recommended them.

When extreme obesity becomes life threatening, and all other treatments have been tried, surgery is a final option. Research indicates that for many people it is a successful and life-changing procedure. However, people who want this type of surgery, and meet the medical criteria for it, must have both their physical health and emotional well being carefully assessed before any decisions are made. They are also fully informed of the potential benefits, as well as the potential risks and pitfalls of the procedures.   

There are different types of procedures, but the most common uses a gastric band that makes the stomach smaller, and so reduces the amount that can be eaten at any one time. This is usually carried out as keyhole surgery, and the band can be surgically adjusted (to make the stomach smaller or larger) or removed if need be. Specialised dietary advice as part of medical follow up is required to help people adjust to and live with their new stomach size, and keep their diet nutritionally adequate. A consumer support group for people interested in weight loss surgery is www.wlsinfo.org.uk

Many people find that attending a group programme suits them as it provides regular support as well as practical information. The three most popular ones in the UK are: Weight Watchers, Rosemary Conley Diet and Fitness Clubs, and Slimming World. There is very limited published research about the long-term effectiveness of slimming clubs, which is a pity, and hopefully more will come. But what there is suggests that the responsible clubs can be useful. Before joining any club we encourage you to find out what it offers and ask yourself what you see as the benefits for you. Most importantly, see if it offers some form of ongoing support to help you maintain your weight loss.

These diets typically involve eating lots of meat, poultry, fish, eggs, cheese and fats; severely restricting carbohydrate-rich foods such as bread, potatoes, cereals and sugars; and limiting most fruits and some vegetables. There is no special magic to these diets; they’re just low calorie diets with a strict and novel set of dietary rules. This means that you end up eating less than usual, and lose weight. Vitamin and mineral supplements are needed, as the diets are not nutritionally adequate. They’re not safe for people with medical conditions such as heart, liver or kidney disease and gout.

A main concern is their restriction of whole grains and many fruits and vegetables (which help protect against cancer and heart disease), and unless lean meats and low fat cheeses are chosen, saturated fat intake is high. There is also currently no evidence that low carb. diets are either healthy to follow, nor help people control their weight in the long-term. But we do know that healthy, balanced diets can achieve both of these things.

Meal replacements are designed to replace two meals, and one or two snacks, which enables you to consume fewer calories than you burn and so lose weight. The products are said to give people a simple and structured, calorie and portion controlled eating pattern, making them easier to follow than diets with a wider range of food choice. Examples of products in the UK are Slimfast, Boots Nutraslim and Tesco’s own brand. There have been some published studies, which show that proper use of meal replacements along with regular support, can provide a nutritionally balanced diet and help people lose, and keep off a healthy 5-10% of their weight. They may not be for everyone but are a useful option. 

These are structured diets where all meals are replaced by specific drinks, soups, bars or desserts which have been specially formulated and are nutritionally adequate – but typically provide 800 calories (some provide 500 calories). Salad, vegetables and fruit may be part of the plan plus additional fluids. They can’t be bought off the shelves, and people following VLCDs require close medical and dietetic supervision.

These include books, magazines and Internet based diets and programmes. There is a vast choice available of widely varying quality. Some can be very helpful, and many are fad diets. Apply the British Dietetic Association’s ‘It’s a fad diet’ test (see below) to check a new diet out. If it isn’t a fad, see how it rates against the ‘responsible diet’ guide at the start of this section.  Since different approaches suit different people, an Internet or self-help book may be the approach that suits you best.